Comparative Analysis of the Efficacy of Transabdominal Pre-Peritoneal Vs Open Tension-Free Hernia Repair in Treating Inguinal Hernia

Objective:To investigate and analyze the clinical outcomes of inguinal hernia patients treated with transabdominal pre-peritoneal repair(TAPP)versus open tension-free hernia repair.Methods:The study was carried out from January 2021 to August 2023,and a total of 50 inguinal hernia patients were selected for this study.The patients were randomly divided into a study group(n=25)and a control group(n=25)by the numerical table method.The patients in the control group were treated with open tension-free hernia repair,whereas the patients in the study group were treated with TAPP.The surgical and postoperative recovery indexes,complication rates,and recurrence rates of the two groups were compared.Results:There was no significant difference in the operative time and intraoperative blood loss between the two groups(P>0.05),and the postoperative feeding time,time out of bed,and hospitalization time of the study group were shorter than those of the control group(P<0.05);the incidence rate of postoperative complications in the study group was lower than that in the control group(P<0.05);and there was no significant difference in the recurrence rate of the two groups after operation(P>0.05).Conclusion:Compared to open tension-free hernia repair,TAPP offers a shorter postoperative recovery duration and hospitalization time,and reduces the incidence of complications.Therefore,this surgical method should be popularized in the treatment of inguinal hernia.

Delayed Mesh Infection: A Rare Complication of Laparoscopic Inguinal Hernia Repair (TEP—Totally Extra-Peritoneal Repair)

Hernias are amongst the oldest afflictions of mankind. The tension-free mesh repairs revolutionized and radically changed the whole concept of anatomical tissue repairs. The introduction of mesh, though beneficial, posed a new set of postoperative problems with the mesh infection being the most morbid one. Laparoscopic surgery has been able to reduce the incidence of mesh infection as opposed to the open hernia repairs. The infection occurs mostly early but rarely does it present several years after the surgery. Herein we report our case of delayed mesh infection developing 6 years postoperatively. This is our first such case in a series of more than 1000 laparoscopic hernia repairs over a period of 6 years (2010-2016). The patient needed an open exploration which revealed a large preperitoneal cavity containing 770 ml of pus with a mesh floating in it. The mesh was removed and the thorough toileting of the wound was done.

Simultaneous Repair of Para-Umbilical Hernia during Cesarean Section (CS): A Novel Approach

Background: Pregnant women that are complaining from paraumbilical hernia postpone its repair until they get birth. We hypothesized that it will be better to perform hernia repair of such type of hernia simultaneously during performing cesarean section (CS) which will help to decrease future morbidity re-operation, avoid complications and further skin incision. In this study we aimed to compare the value of performing para-umbilical hernia repair simultaneously during performing CS through the same skin incision with performing para-umbilical hernia repair simultaneously during performing CS through another infra- or supra-umbilical skin incision and performing para-umbilical hernia repair electively later on after healing of a CS skin incision in relation to clinical recovery and patient satisfaction. Patients and Methods: This is a prospective cohort study, where we included 45 pregnant female patients who will give birth by CS, and we have divided them into 3 groups: the first group of patients (A) included 15 patients that undergoing paraumbilical hernia repair by pre-peritoneal mesh insertion through CS incision, the second group of patients (B) in-cluded 15 patients that undergoing paraumbilical hernia repair by infra- or supra-umbilical incision during CS incision and the third group of patients (C) included 15 patients that undergoing paraumbilical hernia repair by infra- or supra-umbilical incision later on after healing of the CS wound. We have evaluated advantages of that novel approach e.g. operation time, severity of pain, peri-partum and post-operative complications, financial cost, duration of hospital stay, clinical recovery, mesh rejection, and patient satisfaction. Results: In group A there is shorter duration of hospital stay, no new skin incision (p 0.002). Conclusions: Performing para-umbilical hernia repair by insertion of a pre-peritoneal mesh simultaneously during performing CS through the same skin incision is the best method of management of para-umbilical hernia in pregnant woman.

An Experience of Short-Term Results of Laparoscopic Inguinal Hernioplasty Using 3D Mesh in a Developing Country

Background: The experience of short term results of laparoscopic inguinal hernia repair using 3D mesh in a developing country is reviewed. Methods: From January 2012 to February 2014, 53 patients underwent laparoscopic inguinal hernioplasty. A retrospective case series of 53 consecutive patients undergoing TEP/TAPP by a single surgical team was followed prospectively with a focused physical examination and interview. 4 out of 53 patients had recurrent hernia following open repairs and 49 had primary hernias. Data collected included operative time, intraoperative bleeding, intraoperative difficulties, immediate postoperative pain, chronic groin pain, recurrence, sensory disturbance, activity or occupational limitation and personal satisfaction. Results: All the patients were male aged 32 to 75 years with a mean age of 53.5 years. Mean operative time was 37.4 minutes;intraoperative dissection, blood loss were less;and immediate postoperative pain was negligible as assessed by VAS. There was no mortality or major morbidity. Mean follow-up was 12 months (2 to 18 months). Follow-up was completed by interview and physical examination. Hernia was not found to recur during the follow up period. Chronic pain occurred in 2 patients (3.7%), which was mild in nature. Ninety-seven percent of patients were satisfied with their repair and would or had recommended TEP/TAPP to others using 3D Mesh. Conclusions: Short-term results of TEP/TAPP hernia repair using 3D mesh demonstrated to be an effective and safe procedure with low prevalence of chronic pain that is generally of a mild, infrequent nature. It was also concurred that there is decrease in operative time. Manipulation of mesh was significantly reduced. Intraoperative bleeding and use of post operative analgesia was reduced considerably. There was no recurrence, however the cost of the mesh increased the overall cost of the procedure acting as a limiting factor in a developing country.